Adviser on Ministerial Interests

Debate between Karin Smyth and Baroness Winterton of Doncaster

Tuesday 21st June 2022 Commons Chamber

[Karin Smyth]

I think that what the Minister is trying to say is that what has gone wrong is either the process of appointing the last two advisers, or indeed the last two advisers—both of which seem to me to be dishonourable things to say, if I may say so—rather than the fact that both have resigned because of the behaviour, as they have admitted, of a Minister and the Prime Minister.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I do not think the hon. Lady was implying that something dishonourable had been said. If she was, I would want her to withdraw that.

[Karin Smyth]

I withdraw it.

Health and Care Bill

Debate between Karin Smyth and Baroness Winterton of Doncaster

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

The problem we have is that this debate has to finish at 7.55 pm. This means that, after the shadow Minister has spoken, I will have to impose a time limit to get in a lot of Back Benchers. The time limit will start at four minutes.

I call the shadow Minister, Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

Thank you, Madam Deputy Speaker. This Bill has been significantly improved. It delivers changes to the 2012 legalisation the NHS called for. Some other issues have been addressed by ministerial assurances and many valuable new clauses have been added. I am pleased that much of what we argued for in the six weeks of the Bill Committee has finally been accepted. On two issues—the Secretary of State’s powers on reconfiguration, and procurement and modern slavery—the Lords have wrestled important concessions that we support. As a former senior NHS manager, I know that reconfiguration is necessary, important and often difficult; it is often wrongly associated purely with cuts and taking something away. We are interested in improving outcomes for people, and that sometimes requires difficult change. For two decades, a comprehensive process has existed, which includes local people, is informed by expert assessments and operates pretty well. Throughout Committee, and during numerous debates, I have heard no sound argument to change it, but the Government seemed hellbent on doing so, and it is only at the eleventh hour that they have finally agreed to some changes.

If I listened to the Minister correctly, he says that now the NHS will have to notify the Secretary of State when there is something notifiable. That is going to be as clear as mud for everybody, isn’t it? We look forward to the regulations. The point is that the Government’s initial plan inhibits improvement. If NHS managers and, in particular, clinical leaders know that the Secretary of State is hovering, they will be less likely to promote changes that may be clinically necessary but politically difficult. It appears now that the Secretary of State finally agrees and does not want this big pile on his desk, and although the amendment is far from perfect, it does enough for now. On the procurement issue, I commend the work of many people from across both these Houses and the excellent case that has been put forward. Labour has been pushing for measures such as these for many months, and I think the intentions of the Government appear to be aligned to a shared view of what is required.

However, there remain two substantial issues, workforce and the care cap, where I hope the Government, even at this late hour, will listen to reason. Many experts have spoken, and many ideas, alternatives and suggestions have been put forward, but we have had very little engagement from the Government. On these two matters, we speak for the stakeholders, experts and Members from all parties, who are united in opposing the Government’s proposals. Workforce planning is a huge issue in its own right, but it is also fundamental and cuts through everything we are talking about on health and social care. Chiefly, the problem is that unless we face up to the scale of the workforce challenge, the Government will not deliver the shorter waiting times that patients need. Until this Government break out of their straitjacket—unless somebody can make the Chancellor see reason—nothing is going to change for all our constituents. The Government should start today—otherwise patients will be left wondering why they are paying more and more in taxes but waiting longer for care.

Time precludes my repeating all the arguments. I could simply repeat what the Chair of the Select Committee said last time or I could offer the wise words of the previous chief executive of the NHS and more—who can add to the variety and strength of the evidence? The logic of this approach escapes me. Every MP knows that our family, friends and constituents are now in a cycle of long waits in pain and discomfort, with worry. All that is asked for in this Lords amendment is a proper report that sets out the system to address the likely staffing requirements—that is so obviously necessary. If this amendment falls, we, as legislators, have failed. If the Secretary of State will not show leadership, NHS England must step up and produce its own requirements and projections. Additionally, the Local Government Association could commission work across the country, in every local authority, on the needs for social care and public health staff. I suggest that every MP asks their own integrated care system and local authority what workforce requirements and projections they have, and how credible these plans are. Unless we do that, how can anyone have confidence in the delivery for the people we are elected to represent?

Finally, we come to the proposed changes to the care cap calculations. Those were snuck in at the last moment and were not subject to any scrutiny in our six weeks in the Bill Committee. They have not been discussed in any detail at all. The proposals are a less generous version of what was in the Care Act 2014 and this is a massive step backwards. Once again, I could read out a ring binder full of analysis and evidence provided by the legion of stakeholders, none of it complimentary. We hear the repeated claim, “This solves the problem of social care. It is fixed.” It simply is not. Let us leave aside the deeply insulting attitude that the care and support of people in need, who could live better more fulfilled lives, is a “problem” to solve; we should be celebrating the fact that people can live better, for many years longer, with multiple conditions, with decent support and care. We all know that to be true.

The proposals the Government have put forward do not deliver any more care; they just change who pays for it. Money will go to those with assets, and the less you have, the more they will take. The proposals will have no real impact for years, but we all know that people need help now. They will not improve the quality of care by anything like what is needed and will not stop those 15-minute visits. The proposals do nothing to assist working-age adults who have a disability. They do not stabilise the collapsing market for care home place provision. They do not shorten any wait for care or reduce any waiting list. They will have no impact on improving access to care for hundreds of thousands of people currently excluded. They do not address the issues around a care workforce with many vacancies and poor terms and conditions. They do nothing to address the catastrophe of the past decade of cuts to local government. This is not a solution to social care. This ill-thought-out idea should not have been pasted into the Bill. Some more informed Conservative Members have also recognised the unfair impact on the poorest, especially those in parts of the north; levelling up this certainly is not.

Covid-19: Government Transparency and Accountability

Debate between Karin Smyth and Baroness Winterton of Doncaster

Thursday 22nd April 2021 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to follow the hon. Member for Hazel Grove (Mr Wragg). I thank him for the fair and inclusive way in which he has chaired the Committee.

The sense of shock, uncertainty and genuine confusion that the public at large felt as this crisis began was in truth mirrored by the Government. That is at least in part understandable, and I will return to the issues of preparedness later, but the nature, scale and speed of that first wave was unlike anything our Government have ever faced before. It would have tested the boldest of leaders, the best prepared institutions and the most resilient of communities.

My father-in-law died in those early few weeks. I was grateful to be able to attend his funeral, but my children could not. Since last April, tens of thousands of families have faced this trauma, and the loss of life and destruction of our economy is not understandable, nor was it inevitable. The truth is that our leadership was woeful, our institutions already cut to the bone by funding cuts, our communities fractured and frayed, health inequalities widening, and it is no surprise that the poorest have faced the greatest burden.

In a democracy as old as ours, the Government rightly have less power to control us and force compliance than many others across the world, but that means that transparency and accountability are more fundamental to securing our agreement for the common good, and when the very Government who had previously eroded accountability and shirked transparency asked us to make those sacrifices, there were bound to be tensions. The starting point of distrust and dysfunction was made much worse by the unpreparedness with which we entered this emergency.

Emergency preparedness, resilience and response is a term that we use to make sure that we are safe before, during and after an emergency and national disaster. At our Committee session on 29 April the Chancellor of the Duchy of Lancaster appeared to talk about the work of the Cabinet Office, and we looked at preparedness. The pre-2020 timeline to our report is really important. Public Health England’s pandemic flu strategic framework in 2014 had as a key principle preparing for the worst. That 2014 document built on work in 2011, which followed work in 2009 regarding the previous flu crisis. In 2016 Operation Cygnus, the exercise conducted to understand our preparedness and test our resilience in response, was shrouded in mystery, and it was only released in October 2020, as even The Daily Telegraph reported, following legal action and the threat of the Information Commissioner. That document really exposed how poorly prepared we were.

In addition, in our meeting with the Chancellor of the Duchy of Lancaster in April we discussed the national risk register, which had not been published since 2017; it is supposed to be published every two years. I asked him whether the Cabinet Office monitored whether various Departments and agencies had completed the mitigations in previous risk registers. He answered that it was the Cabinet Office’s responsibility to do so. He wrote to us later, on 21 May, with less clarity on the Cabinet Office’s role, simply stating that work on the risk register for 2019—for 2019—was advanced, but would need to be recalibrated in light of the current pandemic.

Also, we were running the NHS at over 90% of capacity, when the Royal College of Emergency Medicine and many other royal colleges had been warning that 85% was more in line with patient safety requirements. That, plus the additional year-on-year Government cuts, including to public health, all meant that we were not prepared when we could have been, and any look back at this dreadful time in our history needs to expose that failure.

But fundamentally and unforgivably, we were hamstrung by this Government’s ideological opposition to the very things that could have helped save lives—an ideological opposition to experts, an ideological opposition to local government and local expertise, an ideological opposition to the principles of good public health. And what was it replaced with? The absurd reliance on mates and acquaintances—approaching a pandemic in much the same way as most of us would look for someone to plaster our bathroom. Underpinning it, the idolatry of the private sector, trumping every time the institutions and people who actually understood the communities we were looking to protect.

Crucially, the Government were bereft of a strategy, with no accountability, and that includes the legislation and our role as Members of Parliament who were presented with that rushed legislation and reliance on ancient public health Acts, rather than the Civil Contingencies Act 2004 and the scrutiny that had happened in this place before—a problem that we are still trying to extricate ourselves from.

The key part of that Civil Contingencies Act was the reliance on local resilience forums. None of us live in Whitehall; we live in our communities. That is why local forums are so critical, and any response should have been driven bottom-up and then supported by the national effort—and that is where so much damage has been done, in that local response.

For everything we have learned in our Committee, the transcripts are really quite shocking. As a previous emergency planner and someone who has worked closely with public health, I expected certain things to happen, and they did not. The test and trace debacle is the most obvious case in point—so many lives lost, so much time lost. Why would the Government not trust local leaders, and our colleagues in councils of all political colours, to get the job done that they were trained to do? Over the border from me only 20 miles, in Wales, the Welsh Test, Trace, Protect system is run as a public service and has delivered, by any measure, better outcomes for vastly less public money.

Things have got a bit better in terms of the local-national interface and response, but there are still some real issues that are hampering the public health response now and for the future. First, we must not reorganise the organisation that is doing this at national level in the middle of a pandemic and make people fearful of losing their jobs when they are trying to save our lives. Secondly, the consequence of the Lansley Act is that public health expertise in local government does not have the same access to NHS data that previously occurred. That has hampered the public health effort locally. Public health officials in local government need to be able to access data for public benefit and recognise the difference between identifiable personal data and non-identifiable data. That is something the Government can do something about.

We have to use this excellent report to look to the future. Does anyone here think that everything will be normal after 21 June? Again, after everything we have been through, the Government are still not on the front foot. They are still too late, as demonstrated by the decision about India going on the red list this week. I do not think everything returns to normal after 21 June, and the Prime Minister has now started hinting about a third wave. That means he has to take some actions. We are all so very weary. We are desperate to see our loved ones. We are desperate for everyone to get back to work, to go on holiday, to start planning our lives now. Our young people need radical change in our education system to be prepared for the future. Decisions need to be made now. We all want to be able to visit care homes and have people able to leave those care homes. It is an absolute disgrace, but the urgency is missing.

In conclusion, I am very proud to be a part of this Committee. I commend our Chair for the fair and inclusive way he has conducted it. Our Clerks and advisers have been superb in their support and responsiveness to allow us to do some great work in difficult conditions. I thank them for report they produced, and I thank our great witnesses. The Government, however, have not learned the lessons. I am not confident that they have taken on board these recommendations. If we are to secure compliance for the next stage, that really needs to happen: we need honesty and transparency about the data; honesty about the political choices that face us; honesty about the balance of risk; and, frankly, more respect for Parliament and the people we represent.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I reiterate that we need to keep to five minutes, otherwise I will put on a time limit.